Randomised Controlled Trial of Study Without Stress: A Cognitive Behavioural Therapy Program to Reduce Stress in Students in the Final Year of High School


Typically students in their final year of school report high levels of anxiety, depression and stress. This study evaluated Study without Stress, a group cognitive behavioural program to reduce student stress. Fifty-six final year students (77% female) from four Australian secondary schools were randomly allocated to Study without Stress delivered by school staff, or to an 8-week usual care condition. Changes in self-reported stress, anxiety, depression, self-efficacy, and teacher reported emotional problems were assessed pre to post-treatment using intent-to-treat analyses. Maintenance of changes were examined 3-months later. Compared to usual care, Study without Stress led to significant reductions in self-reported stress and distress, and increases in self-efficacy that were maintained over time, with no significant changes in anxiety, depression or teacher reported emotional problems. Study without Stress is beneficial for reducing academic stress and improving self-efficacy in final year students when delivered in a school setting.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Anderson LW (2005) The No Child Left Behind act and the legacy of federal aid to education. Educ Policy Anal Arch. https://doi.org/10.14507/epaa.v13n24.2005

    Article  Google Scholar 

  2. 2.

    Wuthrich VM, Jagiello T, Azzi V (2020) Academic stress in the final years of school: a systematic literature review. Child Psychiatry Hum Dev 51:986–1015

    PubMed  Article  Google Scholar 

  3. 3.

    Robinson JA, Alexander DJ, Gradisar MS (2009a) Preparing for Year 12 examinations: predictors of psychological distress and sleep. Aust J Psychol 61(2):59–68

    Article  Google Scholar 

  4. 4.

    Smith L, Sinclair KE (2000) Transforming the HSC: affective implications. Change Transform Educ 3(2):67–79

    Google Scholar 

  5. 5.

    Leonard NR et al (2015) A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools. Front Psychol 6:1028–1044

    PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Vogel S, Schwabe L (2016) Learning and memory under stress: implications for the classroom. NPJ Sci Learn 1:16011

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Putwain D, Daly A, Chamberlain S, Sadreddini S (2015) Academically buoyant students are less anxious about and perform better in high-stakes examinations. Br J Educ Stud 85(3):247–263

    Google Scholar 

  8. 8.

    Tennant C (2002) Life events, stress and depression: a review of recent findings. Aust N Z J Psychiatry 36(2):173–182

    PubMed  Article  Google Scholar 

  9. 9.

    Zuckerman M (1999) Diathesis-stress models. In: Vulnerability to psychopathology: a biosocial model. American Psychological Association: Washington, DC, pp 3-23

  10. 10.

    Einstein DA, Lovibond PF, Gaston JE (2000) Relationship between perfectionism and emotional symptoms in an adolescent sample. Aust J Psychol 52:89–93

    Article  Google Scholar 

  11. 11.

    Lay CH, Edwards JM, Parker JD, Endler NS (1989) An assessment of appraisal, anxiety, coping, and procrastination during an examination period. Eur J Pers 3(3):195–208

    Article  Google Scholar 

  12. 12.

    Peluso MA, Savalli C, Curi M, Gorenstein C, Andrade LH (2010) Mood changes in the course of preparation for the Brazilian university admission exam—a longitudinal study. Rev Bras Psiquiatria 32:30–36

    Article  Google Scholar 

  13. 13.

    Smith L, Sinclair KE, Chapman ES (2002) Students’ goals, self-efficacy, self-handicapping, and negative affective responses: an Australian Senior School Student Study. Contemp Educ Psychol 27:471–485

    Article  Google Scholar 

  14. 14.

    Yeni Palabiyik P (2014) A study of Turkish high school students’ burnout and proficiency levels in relation to their sex. Novitas-ROYAL (Research on Youth and Language) 8(2):169–177

    Google Scholar 

  15. 15.

    Wuthrich VM, Belcher J, Kilby C, Jagiello T, Lowe C (under review). Tracking academic stress in adolescents across the final year of high school: a longitudinal study. J Sch Psychol

  16. 16.

    Chamberlain S, Daly AL, Spalding V (2011) The fear factor: students’ experiences of test anxiety when taking A-level examinations. Pastor Care Educ 29(3):193–205

    Article  Google Scholar 

  17. 17.

    Putwain D, Roberts CM (2009) The development of an instrument to measure teachers’ use of fear appeals in the GCSE classroom. Br J Educ Psychol 79:643–661

    PubMed  Article  Google Scholar 

  18. 18.

    Robinson JA, Alexander DJ, Gradisar MS (2009b) Preparing for Year 12 examinations: predictors of psychological distress and sleep. Aust J Psychol 61:59–68

    Article  Google Scholar 

  19. 19.

    Neil AL, Christensen H (2007) Australian school-based prevention and early intervention programs for anxiety and depression: a systematic review. Med J Aust 186(6):305–308

    PubMed  Article  Google Scholar 

  20. 20.

    Corrieri S et al (2013) School-based prevention programs for depression and anxiety in adolescence: a systematic review. Health Promot Int 29(3):427–441

    PubMed  Article  Google Scholar 

  21. 21.

    Chorpita BF et al (2011) Evidence-based treatments for children and adolescents: an updated review of indicators of efficacy and effectiveness. Clin Psychol (New York) 18(2):157–172

    Google Scholar 

  22. 22.

    Reynolds S, Wilson C, Austin J, Hooper L (2012) Effects of psychotherapy and anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev 32(4):251–262

    Article  PubMed  Google Scholar 

  23. 23.

    Werner-Seidler A, Perry Y, Calear AL, Newby JM, Christensen H (2017) School-based depression and anxiety prevention programs for young people: a systematic review and meta-analysis. Clin Psychol Rev 51:30–47

    PubMed  Article  Google Scholar 

  24. 24.

    Perry Y et al (2017) Preventing depression in final year secondary students: school-based randomized controlled trial. J Med Internet Res 19(11):e369

    PubMed  PubMed Central  Article  Google Scholar 

  25. 25.

    Hains AA (1992) Comparison of cognitive behavioural stress management techniques with adolescent boys. J Couns Dev 70(5):600–605

    Article  Google Scholar 

  26. 26.

    Khanehkeshi A (2014) Effectiveness of cognitive behavior therapy on academic stress among high school students. Indian J Fundam Appl Life Sci 4:681–694

    Google Scholar 

  27. 27.

    Hains AA (1994) The effectiveness of a school-based, cognitive-behavioral stress management program with adolescents reporting high and low levels of emotional arousal. Sch Counselor 42(2):114–125

    Google Scholar 

  28. 28.

    Wuthrich VM, Passe-de Silva R (2007) Study without stress program, 1st edn. Macquarie University, Macquarie

    Google Scholar 

  29. 29.

    Wuthrich VM, Lowe C (2015) Study without Stress program. Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Sydney

    Google Scholar 

  30. 30.

    King JK, Ollendick TH, Prins PJM (2000) Test anxious children and adolescents: psychopathology, cognition, and psychophysiological reactivity. Behav Change 17:134–142

    Article  Google Scholar 

  31. 31.

    Putwain D (2008) Deconstructing test anxiety. Emotion Behav Difficult 13(2):141–155

    Article  Google Scholar 

  32. 32.

    Hewitt PL, Dyck DG (1986) Perfectionism, stress and vulnerability for depression. Cognit Ther Res 10(1):137–142

    Article  Google Scholar 

  33. 33.

    Beck AT, Emery G (1985) Anxiety disorders and phobias: a cognitive perspective. Basic Books, New York

    Google Scholar 

  34. 34.

    Beck AT (1967) Depression: clinical, experimental and theoretical aspects. Harper & Row, New York

    Google Scholar 

  35. 35.

    Lewinsohn PM, Shaffer M (1971) Use of home observations as integral part of treatment of depression—preliminary report and case studies. J Consult Clin Psychol 37(1):87–94

    PubMed  Article  Google Scholar 

  36. 36.

    Frost RO et al (1990) The dimensions of perfectionism. Cognit Ther Res 14(5):449–468

    Article  Google Scholar 

  37. 37.

    Hewitt PL, Flett GL (1991) Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. J Pers Soc Psychol 60(3):456470

    Article  Google Scholar 

  38. 38.

    Lovibond S, Lovibond P (1995) Manual for the depression anxiety stress scales. Psychology Foundation of Australia, Sydney

    Google Scholar 

  39. 39.

    Tully PJ, Zajac IT, Venning AJ (2009) The structure of anxiety and depression in a normative sample of younger and older Australian adolescents. J Abnorm Child Psychol 37:717–726

    PubMed  Article  Google Scholar 

  40. 40.

    Willemsen J, Markey S, Declercq F, Vanheule S (2011) Negative emotionality in a large community sample of adolescents: the factor structure and measurement invariance of the short version of the depression anxiety stress scales (DASS-21). Stress Health 27(3):120–128

    Article  Google Scholar 

  41. 41.

    Henry JD, Crawford JR (2005) The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 44(2):227–239. https://doi.org/10.1348/014466505X29657

    Article  PubMed  Google Scholar 

  42. 42.

    Ng F, Trauer T, Dodd S, Callaly T, Campbell S, Berk M (2007) The validity of the 21-item version of the Depression Anxiety Stress Scales (DASS-21) as a routine clinical outcome measure. Acta Neuropsychiatr 19:304–310. https://doi.org/10.1111/j.1601-5215.2007.00217.x

    Article  PubMed  Google Scholar 

  43. 43.

    Muris P (2001) A brief questionnaire for measuring self-efficacy in youths. J Psychopathol Behav Assess 23(3):145–149

    Article  Google Scholar 

  44. 44.

    Suldo SM, Shaffer EJ (2007) Evaluation of the self-efficacy questionnaire for children in two sample of American adolescents. J Psychoeduc Assess 25(4):341–355

    Article  Google Scholar 

  45. 45.

    Goodman R, Meltzer H, Bailey V (1998) The strengths and difficulties questionnaire: a pilot study on the validity of the self-report version. Eur Child Adolesc Psychiatry 7:125–130

    PubMed  Article  Google Scholar 

  46. 46.

    Goodman R (2001) Psychometric properties of the Strengths and Difficulties Questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345

    PubMed  Article  Google Scholar 

  47. 47.

    Jagiello T, Wuthrich VM, Ellis L (2020) Implementation trial of the Study without Stress program in a secondary school. Manuscript in preparation

  48. 48.

    Carroll A et al (2009) Self-efficacy and academic achievement in Australian high school students: the mediating effects of academic aspirations and delinquency. J Adolesc 32(4):797–817

    PubMed  Article  Google Scholar 

  49. 49.

    Chemers MH, Hu L, Garcia BF (2001) Academic self-efficacy and first-year college student performance and adjustment. J Educ Psychol 93(1):55–64

    Article  Google Scholar 

  50. 50.

    Greene BA, Miller RB, Crowson M, Duke BL, Akey KL (2004) Predicting high school students’ cognitive engagement and achievement: contributions of classroom perceptions and motivation. Contemp Educ Psychol 29(4):462–484

    Article  Google Scholar 

  51. 51.

    Multon KD, Brown SD, Lent RW (1991) Relations of perceived self-efficacy beliefs to academic outcomes: a meta-analytic investigation. J Couns Psychol 38(1):30–38

    Article  Google Scholar 

  52. 52.

    Zimmerman BJ, Bandura A (1994) Impact of self-regulatory influences on writing course attainment. Am Educ Res 31(4):845–862

    Article  Google Scholar 

  53. 53.

    Neil L, Smith M (2017) Teachers’ recognition of anxiety and somatic symptoms in their pupils. Psychol Sch 54:1176–1188

    Article  Google Scholar 

  54. 54.

    Durlak JA, Weissberg RP, Dymnicki AB, Taylor RD, Schellinger KB (2011) The impact of enhancing students’ social and emotional learning: a meta-analysis of school-based interventions. Child Dev 82(1):405–432

    PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Viviana M. Wuthrich.

Ethics declarations

Conflict of interest

The authors declared that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lowe, C., Wuthrich, V.M. Randomised Controlled Trial of Study Without Stress: A Cognitive Behavioural Therapy Program to Reduce Stress in Students in the Final Year of High School. Child Psychiatry Hum Dev 52, 205–216 (2021). https://doi.org/10.1007/s10578-020-01099-x

Download citation


  • Academic stress
  • Cognitive behaviour therapy
  • Senior school
  • Exam anxiety
  • Stress, anxiety, depression